The rate at which people are affected by NCDs has never been higher. According to research by [1], noncommunicable diseases account for more than 35 million deaths annually around the world. Almost 80% of these deaths take place in poor and middle-income countries and affect persons younger than 60. It is widely acknowledged that noncommunicable diseases pose a significant obstacle to sustainable development, which is why they were included in the 2030 Agenda. The agenda’s goal is to reduce premature death from NCDs by one third by focusing on prevention and treatment. To achieve this goal, by 2030, heads of state and government have pledged to implement aggressive national solutions (SDG target 3.4). The World Health Organization (WHO) is an essential leader in the worldwide effort to combat noncommunicable diseases (NCDs) to reach objective 3.4 of the Sustainable Development Goals.

To speed up efforts to prevent and control NCDs, the World Health Assembly has extended the WHO Global action plan for the prevention and control of NCDs 2013-2020 to 2030 and urged the creation of an Implementation Roadmap 2023 to 2030. The roadmap backs initiatives to reach nine global targets that will have the greatest effect on NCD prevention and management. A person under the age of 70 dies from a noncommunicable disease every two seconds, according to the [7]. Heart disease, cancer, diabetes, and lung disease are increasingly more common killers than infectious diseases worldwide.

According to the [8], the term "NCD" can refer to a wide variety of illnesses. Global efforts to prevent and control noncommunicable diseases (NCDs) were formally centered on four diseases and four main risk factors in 2011, following the first-ever High-level Conference of the United Nations General Assembly on the Prevention and Control of NCDs. The term "4 x 4 NCD agenda" was coined to describe this plan. This was expanded to cover mental health issues and air pollution at a later UN High-level Conference in 2018. The "5 x 5 NCD agenda" now describes these goals. NCDs, often known as chronic diseases, are caused by a variety of variables including genetics, physiology, the environment, and even how people choose to behave.

According to the World Health Organization (2018), noncommunicable diseases accounted for 40.5 million of the world's 56.9 million deaths in 2016. Deaths from cardiovascular disease accounted for nearly half (44%) of all NCD deaths in 2016, followed by cancer (9.0 million; 22%), respiratory disorders such as asthma and COPD (3.8 million; 9%), and diabetes (1.6 million; 2%). More than 80% of all NCD deaths occur before their natural time. Rapid increases in the incidence of NCDs are expected to make them the leading cause of mortality in Africa by 2030, surpassing even communicable, maternal, perinatal, and nutritional illnesses by 2020 [9]. It is widely understood that NCDs impact the impoverished in the world's poorest countries. The poor countries of sub-Saharan Africa, among which Nigeria figures prominently, appear to be the hardest hit. This is because many of these people lack access to the resources necessary to prevent and treat noncommunicable diseases. With so few resources available, the priority is on lowering infant and maternal mortality rates due to communicable diseases and other avoidable causes. As a result, it is not an exaggeration to call the current state of affairs in developing countries a health, social, and economic disaster in the making [2].

Recently, WHO (2018) key facts, reported the following:

• Non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally.
• Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these "premature" deaths occur in low- and middle-income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature NCD deaths.
• Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
• Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.

This surge in focus on noncommunicable diseases (NCDs) in developing countries debunks the idea that NCDs primarily affect the wealthy. The rich world is just as guilty of this plague as the rest of the world, but the developing world is bearing the brunt of it. There has been a shift in focus away from communicable diseases and towards non-communicable diseases in the industrialised and high-income countries. The devastating effects of this double illness load on a continent with already scarce resources highlight the critical importance of prompt, effective intervention there [1]. Yet, majority of the world's population resides in middle and low-income countries like Nigeria, where about 80% of the burden of NCDs is already being felt [1]. Cancer, cardiovascular disease, stroke, chronic respiratory illness, and diabetes are among the leading causes of death worldwide, claiming the lives of millions of people each year [10]. Like with many other developing nations, Nigeria is seeing the effects of this worldwide epidemic.

Concept of Non-Communicable Diseases

A non-communicable disease is a long-term health problem that cannot be spread from person to person due to the fact that it is not caused by an infectious process (either acute or chronic). It's not something that goes away on its own and, unfortunately, full recovery is unusual. These illnesses claim more lives each year than any other group of killers around the world [11]. Heart disease, diabetes, stroke, peripheral vascular disease, injuries, cancer, and COPD are all examples of non-communicable diseases (COPD). As such, early diagnosis of these disorders is crucial for reducing their negative impact on human health.

Seventy-five percent or more of all deaths in the world today are caused by diseases that cannot be spread from person to person [3]. The combined weight of health care expenditures and lost productivity makes the financial impact of NCDs enormous. There are several shared risk factors for these diseases [4]. Cardiovascular disorders (including heart attacks and strokes), malignancies, chronic respiratory diseases (including COPD and asthma), and diabetes are the four most common types of NCDs (WHO 2015). Tobacco use, excessive alcohol consumption, an unhealthy diet, and a lack of physical activity are the four key behavioural risk factors shared by the four leading or major NCDs (cardiovascular disease, cancer, respiratory illness, and diabetes). They, in turn, cause a cascade of adverse metabolic and physiological effects, including but not limited to: hypertension, obesity, diabetes, and high cholesterol [10].

Only cardiovascular disease, diabetes, respiratory disease, and cancer will be considered as NCDs in this analysis. Conditions affecting the cardiovascular system are known together as cardiovascular diseases (CVDs). Diseases of the heart and blood vessels, brain and arteries, rheumatic and congenital heart conditions, and thromboembolic disorders such as deep vein thrombosis and pulmonary embolism are all on the list. Blockages in blood vessels leading to the heart or brain are the most common causes of sudden cardiac arrest and cerebral infarction (WHO, 2019). Most often, this is due to a buildup of fatty deposits on the inner walls of the blood arteries that supply the heart or brain. Strokes can be brought on by either the rupture of a brain artery or the formation of a clot in the bloodstream. Cardiovascular diseases (CVDs) remain the top cause of mortality around the world in 2019, per the World Health Organization (WHO). Around 75% of all CVD deaths occur in low and middle income nations. Tobacco use, poor nutrition leading to obesity, lack of exercise, and excessive alcohol use were also cited as preventable causes of cardiovascular disease. A growing number of people in Sub-Saharan Africa are suffering from noncommunicable diseases like cardiovascular disease, as reported by [5]. (SSA). More than 40% of patients with diabetes are unaware of their diagnosis, and hypertension diagnosis, treatment, and control rates are all below average in SSA, at 40%, 35%, and 10- 20%, respectively. Hypertensive heart disease, cardiomyopathy, and rheumatic heart disease are the primary causes of heart failure in low- and middle-income regions, respectively; ischemic heart disease accounts for 10% of cases in SSA compared to >50% in high-income regions.

According to [6], cardiovascular disease is still the leading killer across Europe. Premature deaths in people under the age of 70 due to cardiovascular disease are a major problem in Europe, where the disease claims the lives of over 60,000 people every year. Substantial disparities in illness, treatment, and death exist between countries on the continent, and addressing these disparities should be a top priority. The data that is readily available also varies greatly from one country to the next. Consistent surveillance and monitoring is required across all nations so that we can quantify the health impact of CVD, prioritise interventions, and give motivation for action across Europe. According to the CDC, cardiovascular disease is the top cause of death for both sexes and the majority of American races and ethnicities in the year 2012. In the United States, cardiovascular disease is the leading cause of death, killing one person every 34 seconds. Cardiovascular diseases (CVDs) cost the United States over $229 billion annually between 2017 and 2018, accounting for about 1 in every 5 fatalities in the country. In 2020, about 697,000 Americans died from CVDs. Expenses like these include medical care, medication, and missed wages due to illness or death.

To put it simply, cancer is the unchecked proliferation of aberrant cells. Malignant cells are also known as tumour cells or aberrant cells. The cells are capable of migrating into healthy tissue. A further identifier for many malignancies and the aberrant cells that make up cancer tissue is the tissue from which the cancer first developed (example of such cells are, lung cancer, breast cancer, and colon cancer). According to the [12], cancer will be the sixth biggest cause of death in the world in 2020, with an estimated 10 million lives lost to the disease. Tobacco use, obesity, alcohol usage, inadequate eating of fruits and vegetables, and insufficient exercise all contribute to about a third of all cancer-related fatalities. Human papillomavirus (HPV) and hepatitis are two of the most common cancer-causing illnesses, both responsible for over 30% of cancer cases in low and lower-middle income nations. Researchers found that many tumours are curable if diagnosed and treated early enough. Cancer is the second highest cause of mortality in the United States, and a serious public health concern globally. It is estimated that there will be 1,918,030 new cases of cancer and 609,360 cancer fatalities in the United States in 2022. Lung cancer will be the largest cause of cancer death, accounting for about 350 deaths each day [13]. There were four (4) million new instances of cancer (excluding non-melanoma skin cancer) and 1.9 million deaths connected to cancer in Europe, according to [14]. In women, breast cancer accounts for 530,000 diagnoses annually, while colon-rectal cancer, lung cancer, and prostate cancer round out the top five (470,000). Half of Europe's cancer deaths are caused by these four diseases. Lung cancer (380,000 cases annually), colorectal cancer (250,000 cases annually), breast cancer (140,000 cases annually), and pancreatic cancer (130,000 cases annually) are the leading causes of cancer-related mortality. Estimated new instances of cancer in the EU-27 amount to about 1.4 million in men and 1.2 million in women, with over 710,000 deaths attributable to cancer in men and 560,000 deaths.

Despite several initiatives aimed at preventing and controlling cancer, [15] found that it remains a major health problem in China. Cancer is still a severe health issue in China, despite the government's best efforts to combat the disease. Disparities in cancer incidence by geography and gender further complicate efforts to bring the disease under control. Many of the 1 billion people who live in Sub-Saharan Africa are affected by the cancer epidemic that has gripped the continent. Disease accounts for 1 in 7 fatalities worldwide and 1 in 4 deaths from non-communicable causes; it is one of the top three causes of premature death in almost all member nations [16].

The rising prevalence of diabetes is a huge public health concern. More than half a billion individuals throughout the world currently have diabetes. (IDF, 2021). High blood glucose (or blood sugar) levels are the hallmark of diabetes, a chronic metabolic disorder that has been linked to long-term damage to the cardiovascular system, as well as the eyes, kidneys, and nervous system. Type 2 diabetes is the most prevalent form, and it is caused by either insulin resistance or an insufficient insulin supply. The prevalence of type 2 diabetes has increased rapidly over the past three decades in countries of all income levels, according to the [17]. Diabetes affects over 422 million people globally, mostly in low- and middle-income countries, and is directly responsible for 1.5 million deaths annually.

[18] reported that the prevalence of diabetes mellitus is increasing throughout Latin America, with higher rates in Mexico, Haiti, and Puerto Rico and lower rates in Colombia. The incidence of diabetes is estimated for the year 2021 and forecasted for the years 2030 and 2045 by the International Diabetes Federation (2021) Diabetes Atlas. Adults aged 20-79 are included in the diabetes prevalence estimationsand include both type 1 and type 2 diabetes, as well as diagnosed and undiagnosed diabetes. An estimated 537 million adults aged 20–79 years worldwide (10.5% of all adults in this age group) have diabetes. By 2030, 643 million, and by 2045, 783 million adults aged 20–79 years are projected to be living with diabetes. Thus, while the world's population is estimated to grow 20% over this period, the number with diabetes is estimated to increase by 46%. Diabetes could be described as a health condition brought about by a prolonged excessive accumulation of sugar in the blood which makes the individual to be unwell as some internal organs of the body are presumed to be affected. Diabetes can be termed a lifestyle disease which could be easily prevented. Considering the cost of treatment and the complications associated with the disease, it is important that the issues of the disease are seriously considered. Diabetes, if not promptly treated, could lead to other disease conditions such as cardiovascular diseases, which pose great threat to productivity and longevity.

The respiratory system (including the lungs) is affected by respiratory disease. Infections, cigarette use, and secondhand smoke as well as radon, asbestos, and other environmental pollutants can all contribute to respiratory illness. Inflammation of the airways and other regions of the lungs can lead to chronic respiratory illnesses. Asthma, COPD, lung cancer, CF, sleep apnea, and silicosis are only a few of the most prevalent lung ailments. People of all ages, from toddlers and teenagers to adults and the elderly, are susceptible to contracting a respiratory illness. Most of these disorders are chronic and have far-reaching effects, not just on the person who has them but also on their loved ones, their community, and the health care system. Asthma and chronic obstructive pulmonary disease are the most prevalent persistent respiratory illnesses (COPD). Asthma and chronic obstructive pulmonary disease (COPD) are responsible for almost 4 million deaths annually and affect nearly half a billion people worldwide. Almost a million of these deaths are considered "premature," meaning they occur in adults younger than 70. Over 90% of these deaths happen in low- and middle-income nations [17].

According to the research of Yang et al. (2022), chronic respiratory disorders are a major cause of death and disability worldwide, impacting tens of millions of people in the United States, China, and Europe alone. Almost three-quarters of the world's chronic obstructive pulmonary disease (COPD) cases are located in LMICs, according to research published in 2019 by [19]. Different patterns of ageing may account for why high-income countries (HICs) continue to have a higher prevalence than low- and middle-income countries (LMICs). They also predicted that the incidence of COPD in LMICs would rise because of the general improvement in life expectancy there. It is not possible to rule out the possibility of underestimate in countries with inadequate health information systems and clinical and research capacities. Our results emphasise the significance of prioritising initiatives to tackle COPD in LMICs in order to significantly reduce the worldwide burden of COPD.

There were 3.2 million fatalities from COPD and 495,000 deaths from asthma, according to [20]. Years of life lost due to COPD ranked eighth overall (YLLs). There were around 545 million people living with a chronic respiratory disease, with about half of those people having COPD and the other half having asthma. Asthma (69%) and COPD (29%), the two most common causes of CRD occurrences, accounted for 62 million. Asthma caused 22.8 million DALYs compared to COPD's 81.6 DALYs. A recent general population sample from Northeastern Italy reported a prevalence of COPD of 9.1%, whereas a 25-year follow-up of a general population sample from Central Italy indicated an increasing prevalence of COPD up to 6.8% and asthma up to 7.8%. Despite the declining burden of COPD, [21] stated that this disease remains a major public health problem, especially in nations with a poor socio-demographic index. To reduce the prevalence of COPD even further, they suggested that smoking cessation, better air quality, and fewer occupational exposures be prioritised in preventive programmes. Over 300 million people globally have chronic obstructive pulmonary disease (COPD), with the majority living in low- and middle-income nations, per research by [22]. One of the four areas designated for priority study in the WHO action plans on NCDs for the years 2008-2013 is chronic respiratory illnesses. The authors conclude that more investigation of COPD's global, rural/urban, and racial/ethnic differences is required. It is important to consider the impact of environmental, home, occupational, and other factors in COPD, as many people with the disease have never smoked.

Major risk factors for non-communicable diseases

Over the past decade, there has been a dramatic increase in the prevalence of noncommunicable diseases among young adults, and this trend is expected to continue as the prevalence of risk factors for these diseases also increases [23]. A risk factor is any factor that raises the likelihood that a person may get a disease, as described by Jackson et al., 2009. Obesity, central adiposity (increased waist to hip ratio), old age, a family history of diabetes, and changes in lifestyle brought on by urbanisation are all significant risk factors for the high incidence of diabetes. Non-modifiable risk variables, also known as host risk factors, and modifiable risk factors, also known as reversible risk factors, are subclassified based on their degree of amenability to change [24].

Some noncommunicable diseases may become more severe if certain risk factors are present. A person's chance of developing a disease increases in proportion to the degree to which they exhibit the characteristic or are subjected to the circumstance known as a risk factor. According to [25], risk factors are "those aspects of an individual's present circumstances that increase the likelihood that that individual will develop an illness or set of disorders within a certain future time period." Risk factors are defined by [21] as "everything known to increase the likelihood that an individual may acquire an illness or develop a condition." Those who have behaviours or traits that raise the likelihood of getting NCDs will be regarded to be at risk. The presence of risk factors is prerequisite to the occurrence they foretell, and the likelihood of having the disease increases as the risk factor's prevalence does. According to the Centers for Disease Control and Prevention, risk factors can be broken down into several categories (2019). There are two types of risk factors: those that cannot be changed and those that can be changed, such as metabolic risk factors. A non-modifiable risk factor is one that cannot be mitigated by taking preventative measures. A few examples are chronological age, sex, ethnicity, and heredity.

Physical inactivity, smoking, alcohol usage, poor food and feeding, lack of sleep, stress, and skipping medical checkups are all examples of modifiable risk factors [10]. According to [11], the four primary behavioural factors connected to NCDs are tobacco use, physical inactivity, alcohol consumption, and a poor diet. Increases in blood pressure, total cholesterol, hyperglycemia, and obesity are all possible outcomes of modifiable risk factors. Several non-communicable diseases have modifiable risk factors that are linked to an individual's way of life and increase the possibility of developing a certain condition. Tobacco use, excessive alcohol use, sedentary lifestyle, poor diet, hypertension, obesity, high cholesterol levels, and diabetes were the leading causes of death [26]. Long-term exposure to risk factors, many of which are related to individual behaviours and environmental variables, leads to these diseases. High blood pressure, cigarette use, insufficient exercise, excess body weight, diabetes mellitus, and high cholesterol are just few of the NCD risk factors that have been recognised as top global risk factors for morbidity and mortality [12].

Reduced physical activity is now recognised as a major contributor to the development of numerous chronic diseases. They include cardiovascular disease, high blood pressure, diabetes (particularly type 2 diabetes), stroke, excess body fat, and Fibromyalgia. More than 5.3 million of the world's 57 million deaths in 2008 could be attributed to a lack of physical activity. About 27.5% of Africans are physically inactive, and 6.3% of deaths in the region can be attributed to that lack of movement. Inactivity among adults in Nigeria accounts for 31.4% of the population [27]. There is a correlation between being overweight or obese and an increased risk of diseases like cancer, diabetes, and heart disease. A small weight decrease can help to alleviate health concerns. Being fully invested in a lifestyle change is your greatest bet for successful weight loss and maintenance. Maintaining a healthy weight can be accomplished by engaging in regular physical activity and consuming a nutritious diet. A medical diagnosis of obesity indicates extreme fatness. If a person is obese or overweight, they have an abundance of fat in their bodies. Being overweight or obese increases a person's risk of acquiring a number of health issues over time, so it's not just about how they appear. By calculating the body mass index (BMI) and measuring the waist circumference, an adult can determine if they are overweight or obese and if their health is at risk. Those who are overweight or obese have a threefold larger risk of developing hypertension than their normal-weight counterparts and a twofold greater risk than underweight ones. The waist-to-hip ratio is a more accurate indicator of health risk than overall body mass. It has been found that a higher waist-to-hip ratio is a stronger predictor of hypertension.

Despite the fact that they cannot be altered, it is crucial that people be made aware of the non-modifiable risk factors of NCDs in order to take preventative measures. Heredity, age, and gender are three examples of such variables. It's been known for a long time that risk factors for acquiring crucial NCDs tend to run in families (genetic predisposition). A person's risk of developing hypertension increases if he or she has a first-degree relative with the condition. Over 75% of hypertension patients, as noted by Thatch and Schutz (2014), have a history of NCDs in their families. According to [28], if both parents have a noncommunicable disease (NCD), their children may be at an increased risk of developing that disease themselves. One risk factor for NCDs that cannot be altered is a person's age. It has been hypothesised that the prevalence of NCDs increases with age. This is reinforced by the research of [29], who found that the optimal closeness between partners for maintaining healthy blood pressure fluctuates with age. As we age, our bodies lose some of their suppleness. Atherosclerosis causes the arteries to harden, which creates more resistance to blood flow. Age is also a significant factor in the development of NCDs, as both their prevalence and mortality rates rise gradually with time.

One of the non-changeable risk factors of NCDs is gender. Up until roughly age 50, men are more likely to suffer from NCDs than women are, but this trend reverses as both sexes age. While women over 65 have a higher risk of getting NCDs than men over 65 do, the likelihood of developing a stroke is directly related to systolic blood pressure regardless of gender and age. According to [30], women experience a sharp increase in their risk of developing atherosclerotic cardiovascular disease during menopause. As a result of the decline of the female oestrogen hormone, which has been shown to have a protective impact against cardiovascular disease and high blood pressure, women are reported to have a higher incidence of NCD’s

Theoretical Framework on Prevention and Control

Theory of Reasoned Action

The theoretical framework for this study is based on the theory of reasoned action. Theory of reasoned action (TRA) was propounded by Ajzen and Fishbein in 1967 to show how attitude impact on behaviour. It suggests that a person's actions are influenced by his expectations of their consequences and by the approval or disapproval of those who matter to him [31]. The implication is that a person's actions are determined by his desire to act in a certain way. This goal is founded on the individual's outlook and his personal standards for this kind of conduct. The desire to do or refrain from the behaviour in question is assumed to be the single and immediate determinant of the conduct in question. As a result, this theory provides an explanation for collective behaviour by focusing on the actions of specific individuals.

According to the theory of reasoned action, an individual's personal attitude towards performing the behaviour in question and the effect of social variables towards the execution of the behaviour are closely related determinants of the purpose to adopt the behaviour. For some behaviours, like driving safely, the normative component is the primary effect on people's intentions, whereas the attitudinal component is the primary influence on other behaviours. Attitude (positive or negative) and the effect of the social environment (generic subjective norms on the conduct) are said to play a role in shaping a person's intention to engage in a certain activity, as proposed by this theory. The idea that a certain outcome will occur if the activity is performed and the appraisal of that outcome are what ultimately shape the person's perspective on the behaviour. A person's incentive to comply with the needs and desires of other people, as well as his or her normative belief about what important or significant others think he or she should do, establish the social or subjective norm. Belief in this philosophy affects one's disposition. A person's attitude towards a certain behaviour can be expected to improve if that person believes that the behaviour will result in favourable results.

Each of the near-by factors in determining intent is founded on some kind of belief system. The mindset shift that's required to change one's behaviour is a result of one's own evaluation of the pros and drawbacks of taking any given course of action, as well as one's own set of preconceived notions about those outcomes. A person may believe that exercising regularly will benefit their health by increasing their fitness and decreasing their risk of heart attack, but that it will also cause them to spend less time with their loved ones. A person's actions are influenced by their own assessment of the repercussions of their various beliefs. So, each person places a unique value on factors like increased fitness, reduced risk of heart attack, and sacrificed family time. The normative aspect is based on the individual's drive to conform to the standards set by their "significant others," as judged by their perception of the expectations of pivotal referent individuals or groups. The patient may believe that his doctor recommends exercising several times a week, but he may not be motivated to really follow the doctor's advice. The premise that external variables are relevant to behaviour only when they have their impact on the variables described in the theory is another part of Fishbein and Ajzen's theory. Human behaviour of interest to social psychologists is supposed to be determined by intention since it is largely thought to be under some degree of volitional control. Hence, the theory of reasoned action acknowledges that personality and other socio-cultural characteristics do influence behaviour, but believes that their influence is a result of underlying attitudes and norms.

Understanding and foreseeing social behaviours are at the heart of the reasoned action. Some researchers have used the notion of reasoned acts to analyse participants' exercise habits. Overall, this approach has been highly useful in regulating and avoiding NCDs by shedding light on the decision-making process underpinning behaviour [11]. classified the risk factors for NCDs as "behavioural factors" due to the fact that these illnesses are often linked to a person's way of life. Consequently, the study of NCD prevention and control could benefit from the theory of reasoned action [32-35].

Prevention and control

Reducing exposure to risk factors is an essential part of managing NCDs. There are easy and inexpensive ways for governments and others to lower the prevalence of widespread modifiable risk factors. Policy and priorities can be improved with the help of data on the prevalence and progression of NCDs. Reducing the risks associated with NCDs and promoting interventions to prevent and control them requires cooperation between multiple sectors, including health, finance, transportation, education, agriculture, planning, and others.

Better management of noncommunicable diseases requires investment. The management of noncommunicable diseases entails not only the diagnosis and treatment of these conditions, but also the availability of palliative care to those who are suffering from them. Primary health care has the potential to strengthen early detection and timely treatment of noncommunicable diseases by delivering high-impact, essential interventions. Provided at an early stage, these interventions have been shown to reduce the need for more expensive treatment, making them a great economic investment. Providing universal access to essential NCD interventions is unlikely in countries with inadequate health care coverage. The SDG target on NCDs cannot be met without interventions in NCD management.

Although there are numerous and complex health system barriers to Non- Physician Health Worker (NPHW) screening, treatment, and control of NCDs and their risk factors, a variety of care models have demonstrated strategies to address nearly all of these obstacles [32]. These enabling approaches-primarily relating to robust, consistent NPHW training, guidance, and logistical support-generate a blueprint for the development and scale-up of such programmes that are applicable across a wide range of chronic diseases, including in high-income countries. To combat the global pandemic of noncommunicable diseases (NCDs), community health nurses (CHNs) can play a pivotal role by employing models of behaviour change.

Nursing Education

The outcome of this study suggest that nursing programmes should regularly incorporate the latest information about the causes, prevention, and treatment of NCDs into their curricula so that they may better prepare their students to combat the growing problem of NCDs. If we're going to effectively combat the global epidemic of noncommunicable diseases (NCDs), continuing education programmes for all types of nurses-but especially CHNs need to focus on these issues. While developing behaviour modification programmes for NCDs, nurses should always make use of evidence-based theories and models, such as the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB), etc.

Nursing practice

Policy makers should push for nurses to implement NCD screening, prevention, and control programmes in all contexts of care (clinical, community, workplaces and schools). The investigation, care, and rehabilitation protocols for NCDs should take into account work shifting and transfer to reduce the burden on physicians. It is imperative that nurses have access to the supplies, drugs, and instruments they need to effectively manage the pandemic of NCDs in clinical settings. Initiating and maintaining campaigns and community mobilisation programmes that target major risk factors of NCDs is an essential part of a community health nurse's job.

Nursing Research: Studies to focus on barriers and challenges of nurses in provision of care, prevention and control of NCDs needs to be conducted and findings from such studies could be used to enhance performance.Simple tools and instruments should be developed for nurses to use in the care and prevention of NCDs in all practice settings.

The following recommendations were made:

• Community members should be encouraged to participate in any training programme organized by professional healthcare givers to improve their knowledge on non-communicable diseases prevention and control so as to foster reduction in negative effects of NCDs
• Nurses and other healthcare workers should intensify effort in educating patients and community members on prevention and control of non-communicable diseases. They should also design different approaches in health education and ensure the approaches are effective strategy for prevention and control of NCDs.
• The government should sponsor provision of information through mass media on prevention and control of non-communicable diseases.

I am obliged to express sincere appreciation to my mentor and chief Supervisor Professor Elizabeth Funmilayo OJO, Dr. Cecilia Bello and all the Faculty members of College of Health Sciences, Afe Babalola University Ado-Ekiti (ABUAD) for the support, inspiration and contributions towards actualizing of this work.

I also appreciate the founder of ABUAD Aare Afe Babalola, for his continuous efforts in providing a conducive environment and opportunity to become part of ABUAD.

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